Stack versus Te Technique for Central Slip Reconstruction during Vascularized Toe Proximal Interphalangeal Joint Transfer

BACKGROUND: Significant extension deficit is a common problem after a vascularized toe proximal interphalangeal joint transfer. One of the main causes related to extensor lag is central slip deficiency of the donor toes. In their clinical practice, the authors performed both the Stack and Te techniques to reconstruct central slip function during a joint transfer. The aim of this study was to compare the long-term outcomes of vascularized joint transfers between these two techniques.

METHODS: From May of 2009 to October of 2021, 38 digits in 36 patients (28 men and 8 women) underwent free vascularized toe joint transfer requiring central slip reconstruction. Eight and 30 digits were reconstructed with the Stack technique and the Te technique, respectively.

RESULTS: The median length of follow-up was 19 months (range, 5 to 78 months). The overall median extension lag was 20 ± 20 degrees and flexion was 80 ± 20 degrees. There were no significant differences in extension lag (25 ± 29 degrees versus 20 ± 15 degrees; P = 0.281), flexion (75 ± 10 degrees versus 85 ± 20 degrees; p = 0.13), or range of motion (53 ± 23 degrees versus 63 ± 15 degrees; P = 0.076) of the joints between the Stack and Te techniques after the transfers.

CONCLUSIONS: From the limited number of cases, both the Stack and Te techniques provided similar outcomes in correcting extension lag in vascularized joint transfers. The Te technique is a simplified and effective method for central slip reconstruction, whereas caution is advised when using the Stack technique because of potential complications.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.